Sylvester John E, Blasko John C, Grimm Peter D, Meier Robert, Malmgren Judith A
Seattle Prostate Institute at Swedish Hospital, Seattle, WA 98155, USA.
Int J Radiat Oncol Biol Phys. 2003 Nov 15;57(4):944-52. doi: 10.1016/s0360-3016(03)00739-9.
The role of external beam radiation therapy in addition to brachytherapy continues to be scrutinized for long term control of PSA levels after prostate cancer diagnosis.
We report 10-year biochemical relapse-free survival (BRFS) on 232 patients presenting with localized prostate cancer and consecutively treated with iodine(125) (I(125)) or palladium(103) (Pd(103)) brachytherapy and neoadjuvant external beam radiation therapy. Multivariate regression analysis was used to create a pretreatment clinical prognostic risk model using a modified ASTRO consensus definition (two consecutive rises in serum PSA) as the outcome. Gleason scoring was performed by pathologists at a small community hospital. Derived risk categories are the following: low = PSA <or=10 ng/mL, Gleason sum score <7, and stage <T2c; intermediate = PSA >10 ng/mL or Gleason Score >or=7 or stage >or=T2c (1 intermediate risk factor); and high = 2 or more intermediate risk factors. Time to PSA failure (local, distant, or biochemical) was calculated and compared using Kaplan-Meier plots.
Ten-year BRFS for the entire treatment group was 70%. Biochemical control rates by risk cohort analysis (95% confidence interval): low risk, 85% (83.3-90.7%); intermediate risk, 77% (73.0-84.5%); and high risk, 45% (45.4-57.2%). Using a risk grouping proposed by the Mt. Sinai group, the BRFS was: low risk, 84%; intermediate risk, 93%; and high risk, 57%. Grouping by the risk classification used by D'Amico, the BRFS was: low risk, 86%; intermediate risk, 90%; and high risk, 48%.
I(125) or Pd(103) brachytherapy, as a boost combined with EBRT, continues to result in high rates of biochemical control at 10 years. Different risk group classification schemes lead to different BRFS results.
对于前列腺癌诊断后前列腺特异性抗原（PSA）水平的长期控制，除近距离放射治疗外，外照射放疗的作用仍在接受审视。
我们报告了232例局限性前列腺癌患者的10年无生化复发生存率（BRFS），这些患者连续接受碘（125）（I（125））或钯（103）（Pd（103））近距离放射治疗及新辅助外照射放疗。多变量回归分析用于创建一个预处理临床预后风险模型，以改良的美国放射肿瘤学会（ASTRO）共识定义（血清PSA连续两次升高）作为结果。由一家小型社区医院的病理学家进行 Gleason评分。得出的风险类别如下：低风险 = PSA≤10 ng/mL，Gleason总分＜7，且分期＜T2c；中风险 = PSA＞10 ng/mL或Gleason评分≥7或分期≥T2c（1个中风险因素）；高风险 = 2个或更多中风险因素。使用Kaplan-Meier曲线计算并比较PSA失败时间（局部、远处或生化）。
整个治疗组的10年BRFS为70%。按风险队列分析的生化控制率（95%置信区间）：低风险，85%（83.3 - 90.7%）；中风险，77%（73.0 - 84.5%）；高风险，45%（45.4 - 57.2%）。采用西奈山小组提出的风险分组，BRFS为：低风险，84%；中风险，93%；高风险，57%。按照达米科使用的风险分类进行分组，BRFS为：低风险，86%；中风险，90%；高风险，48%。
I（125）或Pd（103）近距离放射治疗作为与外照射放疗联合的强化治疗，10年时仍能实现较高的生化控制率。不同的风险组分类方案导致不同的BRFS结果。
